The 340B Drug Pricing Program was designed to make prescription medications and healthcare services more affordable for uninsured and low-income patients. Established by Congress in 1992, the program was created to help hospitals and clinics provide more comprehensive care to vulnerable communities.
But today, mounting evidence shows the program is no longer serving patients as intended. Instead, questions are growing about whether the program primarily benefits the safety-net, or whether too often, it prioritizes healthcare stakeholders at the expense of patients.
A Program That Grew Too Big, Too Fast
According to a new report by the Congressional Budget Office (CBO), facilities spent nearly $44 billion on 340B drugs in 2021, compared to just $6.6 billion in 2010. The CBO found that the program’s rapid growth has been driven by behaviors that increase federal spending, including:
- Prescribing more, and more expensive, drugs
- Increasing vertical integration among facilities
- Reducing negotiated rebates for insurers
- Expanding services
Some striking examples of vertical integration and facility expansion:
- Between 2013 and 2021, the number of off-site outpatient clinics participating in 340B grew from 6,100 to 27,700,
- Contract pharmacy arrangements expanded significantly from about 2,000 in 2010 to nearly 130,000 in 2021.
These developments have not translated into greater charity care or patient savings. In fact, studies show charity care provided by 340B hospitals has declined since 2018, a troubling sign that patients are being left behind. Additionally, just 23% of contract pharmacies are in medically underserved areas and new contract pharmacies are clustered in ‘affluent and predominantly white’ areas.
The Patient Impact
CCPA has long argued that 340B must work for patients, not profits. Our explainer video highlights how the program too often fails to ensure that discounted medicines reach the people it was designed to help. Without accountability, the program incentivizes practices that boost facility revenue while leaving vulnerable patients with high out-of-pocket costs.
To ensure the 340B program fulfills its original purpose for enabling covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services, lawmakers should implement federal reforms that enhance transparency and oversight of the 340B Drug Pricing Program.
The Solution: The 340B ACCESS Act
That’s why CCPA supports the 340B Affording Care for Communities and Ensuring a Strong Safety-Net Act (340B ACCESS Act). This legislation would:
- Increase transparency and accountability in how 340B savings are used
- Ensure that patients, not middlemen, benefit from discounted drug prices
- Restore the program to its original purpose of supporting underserved communities
The 340B ACCESS Act strikes the right balance: preserving the intent of 340B while closing loopholes that have allowed abuse and unchecked growth.
Now Is the Time for Reform
As CBO’s report makes clear, unchecked program expansion risks undermining patient affordability and increasing costs across the healthcare system. Reform isn’t about eliminating 340B, it’s about protecting patients and ensuring a stronger safety-net.
For the millions of Americans living with chronic conditions, the stakes couldn’t be higher. Congress must act now to pass the 340B ACCESS Act and return the program to its patient-centered mission.